Refractive development in children with Down's syndrome: a population based, longitudinal study. Issue 6 (1st June 2001)

• Record Type: Journal Article
• Authors: Haugen, Olav H; Høvding, Gunnar; Lundström, Isa
• Is Part Of: British journal of ophthalmology. Volume 85:Issue 6(2001)
• Page Start: 714
• Page End: 719
• Publication Date: 2001-06-01
• Subjects: accommodation -- astigmatism -- children -- Down's syndrome -- refractive errors; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjo.85.6.714
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : AIMS: To study the refractive development in children with Down's syndrome longitudinally. METHODS: An unselected population of 60 children with Down's syndrome was followed with repeated retinoscopies in cycloplegia for 2 years or more (follow up 55 (SD 23) months). Accommodation was assessed with dynamic retinoscopy. RESULTS: From longitudinal spherical equivalent values of the right eye, three main categories of refraction were defined: stable hypermetropia (<1.5 D difference between the first and last visit) (n=34), increasing hypermetropia ("hypermetropic shift"; ⩾1.5 D difference) (n=11), and decreasing hypermetropia/development of myopia ("myopic shift"; ⩾1.5 D difference) (n=9). Patients with anisometropia (n=6) were evaluated separately. In the stable hypermetropia group three sublevels were chosen: low (⩽+2.0 D at the last visit), moderate (+2.25 to + 4.0 D), and high (>+4.0 D). An accommodation weakness was found in 55% of the children. Accommodation weakness was significantly less frequent in the stable, low grade hypermetropia group (22%) than in all the other groups (p=0.008). The frequency of astigmatism ⩾1.0 D at the last visit was 57%, the direction of axis being predominantly "with the rule." All the eyes with oblique astigmatism had a side specific direction of axis; the right eyes belonging to the 135° axis group and the left eyes to the 45° axis group. CONCLUSION: A stable, low grade hypermetropia was significantly correlated with a normal accommodation. Accommodation weakness may be of aetiological importance to the high frequency of refractive errors encountered in patients with Down's syndrome. A striking right-left specificity in the oblique astigmatic eyes suggests that mechanical factors on the cornea from the upward slanting palpebral fissures may be a major aetiological factor in the astigmatism.